This article is published in partnership with Scarlateen.com. Hugo Schwyzer co-wrote it with Heather Corinna.
kaylinha13 asks:
Heather Corinna replies:Hello, my name is Christine, I am 20 years old and I have had a boyfriend for about 5 years. We have been having intercourse for over 2 years now but recently, for about 3 months, I have started going to an apostolic church and I am thinking about getting baptised and becoming a Christian. But I have a question about what I should do about my sexual life: should I abandon it until I get married now? Because this is really weighing heavily on my morals. I have asked many friends in my church on their opinion about this, and they tell me that premarital sex causes to leave an open doorway for the devil get in so that he can distort sex after marriage. I know that God will not love me any less or be disappointed in me, but if you sacrifice something for God, it will be so much better for you in the end. Everyone has heard that silly line: "sex stops after you get married". I don't want that to be the case...so will sex be better in marriage or does it really make a difference if I continue to make love to my significant other? Because this sounds like a skeptical concept to me... please help!! Thank you.
While I grew up with some Catholic and ex-Catholic family and can certainly speak to your issues in some respect, I didn't feel like I was the best person to address them. I'm Zen Buddhist, and my spiritual belief system and tradition not only doesn't have a god in it at all, it also has very different attitudes about sex (both in its core principles and also among Buddhists) than most denominations of Christianity and many Christians do. I also don't view sex as marital or premarital. Given all of that, I felt like you could use both an educated answer but also one from someone who understood better what you're grappling with than I could, and could answer you in a far more personal way.
I asked my fantastic friend Hugo Schwyzer if he'd answer your question instead. Hugo is a history and gender studies professor at a community college, an animal rights activist and an Episcopal youth minister. He's very good people. I'm always so impressed with the way he talks about sexuality and Christianity. I think you'll appreciate what he had to say.
(Just FYI for other readers, Scarleteen is space that serves people of a wide range of spiritual belief systems and traditions. So, when Hugo is talking here, understand it is in response to Christine and her belief system: it's not espousing any one belief system as the only or right one for all of us.)
So, here's Hugo:
Dear Christine,
Thanks for writing.
As someone just beginning a new faith journey, it’s understandable that you’d be a bit confused by the messages you’re hearing from your friends in church. Surely, they want the best for you, and they’re giving you information based upon their own understanding of what it is that God wants for us. But even though you’re very new in the church, not even baptized, it’s perfectly okay for you to ask questions – and maybe discover some answers that are different from the ones you’ve been hearing.
First off, you need to know that a lot of what folks say the Bible says about sex isn’t really in the Scriptures at all. There is nothing in the Bible that condemns masturbation (the sin of Onan is about the withdrawal method), nothing that condemns loving and mutually committed homosexual relationships, and very, very little about pre-marital sex. The references in the New Testament to “sexual immorality” and “fornication” are based on a very loose translation of a single Greek word, “porneia (yeah, we get the word “porn” from it) which is better translated as “adultery.” Adultery, of course, is sex that breaks a commitment to someone else. If you were to cheat on your boyfriend (or, if you guys get married, your husband), you would certainly be committing “porneia”. But sex before marriage between two people who are not committed to others? Most scholars think the Bible says nothing about that at all.
Let me suggest, Christine, that God cares more about the content of our sexuality than he does about its form. Traditional Christian sexual ethics are often discussed in the context of what Christians can and can’t do. Some Christians will often say things like “the only form of genital contact sanctioned by God is that which happens in a marriage between one husband and one wife.” The implication is clear: if you get the “form” (heterosexual marriage) right, then the sex that follows is okay. If you haven’t got the form right, then you’ve “fallen short of the mark.”
But “form-based” sexual ethics clearly have their problems.
For example, it ignores entirely the great likelihood that coercion, disrespect, and force can take place within marriage. The Churches did not start condemning marital rape — or even acknowledging that such a concept was possible — until the second half of the twentieth century. Is a situation in which a husband demands sex from his wife against her will somehow more in keeping with the spirit of Christ than a situation in which two unmarried people make love with mutual enthusiasm? If you’re a stickler for “form-based ethics”, you bet. For the most traditional of theologians, marital rape is less of a serious sin than homosexuality or pre-marital sex, because form matters more than content.
“Content” based sexual ethics are concerned with the way in which people, in the process of being sexual, value themselves and their partners. Content-based ethics are deeply concerned with mutuality, with pleasure, and with the willingness of each partner to take responsibility for the physical, spiritual, and emotional consequences of what is done. Form-based ethics teach the Christian to ask the question “Am I allowed to do this?” Content-based ethics teach the Christian to ask “Am I truly loving — in every sense of the word — the person or persons with whom I am doing this, including myself?”
As for marriage, there’s no evidence that sex before marriage ruins sex after.
I know a great many happily married people (my wife and I are two of them) who had great sex while they were dating – and great sex after they were wed. God isn’t in the business of punishing people for pre-marital sex by making the sex they have as husband and wife tedious and unfulfilling! What makes sex in any long-term relationship seem stale is a lack of communication and the habit of taking one’s partner for granted – and that can happen just as easily to folks who were virgins on their wedding night as it can to those who weren’t.
Good, just, and spiritual sex can happen both inside and outside of marriage. And I’m certain that the God you’re just starting to get to know, Christine, cares more about the care and concern that you and your boyfriend share together than he does about the fact that you’re not married.
Focus on the way you treat each other – the content of your relationship – and give thanks for the pleasure you both give and receive. Your friends may quote to you Hebrews 13:4, the chapter which is often mistakenly used to condemn pre-marital sex. (It only condemns infidelity and sex with underage prostitutes if you read the Greek closely). Focus instead on Hebrews 13:15, from the very same chapter. It says that the best sacrifice is the “sacrifice of praise.” You know, even atheists sometimes cry out “Oh God!” when they orgasm; that’s giving thanks for the gift of receiving and sharing pleasure. God made our bodies to give and receive intense joy. When you make love with your boyfriend, thank God for giving you that power and that possibility.
Here are a few links at Scarleteen which might also help you out:
]]>In examining rooms, we see women in terrible pain, but their suffering doesn’t count in Stupak/Pitts world. By banishing abortion from the reform bill, the amendment punishes women who need to end unwanted or unhealthy pregnancies.
We share the stories below and on our website to show what can happen to women physically, financially, and emotionally when they don’t have insurance coverage for abortion. As physicians, we try our best to help these women. As advocates, we will fight to protect their access to abortion.
From Nancy Stanwood, MD, MPH:
My patient Carol was excited to give birth to her first child. Her husband was a Marine serving in Afghanistan. Sadly, in her second trimester, Carol learned that her baby had a lethal anomaly. She and her husband made the difficult decision to have an abortion.
That’s when they learned that the military health insurance they relied on wouldn’t cover the abortion unless Carol’s life was in danger.
Her husband was outraged. He had just flown back from Afghanistan to be with her, and he angrily asked me, “I’m over there defending my country, and they won’t even take care of my family?”
From Natalie Roche, MD:
Renee was 18 years old and in prenatal care for a pregnancy she wanted. Her physician found that she had an elevated white blood count. Renee was diagnosed with acute leukemia.
Her oncologist could not begin treatment. The chemotherapy Renee needed came with a risk of miscarriage that could cause fatal hemorrhaging or infection. She decided to have an abortion to save her life.
But Renee did not have insurance. It took time for her to find a doctor who could perform her abortion. The time she spent searching for a provider she could afford endangered her health. She developed anemia and dangerously low white blood cell and platelet counts. She also entered the second trimester of her pregnancy, making her abortion riskier.
I performed her abortion successfully, and Renee went on to have her treatment for leukemia. I do not know if it was too late.
From Willie Parker, MD, MPH:
A woman who was 16 weeks pregnant and had an alcohol problem came to me for an abortion. She knew that she was not ready to be a mother. But she had a condition with her placenta that made abortion risky, and I had to tell her that the procedure would require a hospital stay, making it much more expensive.
She didn’t have insurance or enough money to cover the termination. She had no choice but to continue the pregnancy. I got her into prenatal care. That was the best I could do.
From Pratima Gupta, MD, MPH:
I wasn’t able to help Anna. She became pregnant unexpectedly and decided to have an abortion. But when I started the paperwork for Anna’s procedure, her insurance coverage was denied. Anna works for the postal service, and as a government employee, she is not allowed to have health insurance coverage for abortion.
I had to tell Anna that I couldn’t provide her abortion, and I gave her the phone numbers of some clinics that could help. In the end, Anna had to borrow money from several friends to pay for her abortion. I will never forget how frightened and frantic she was to learn that her good government health insurance didn’t cover the care she needed.
From Renee E. Mestad, MD:
My patient Sherry is 24, pregnant, and the mother of a 7-month-old son. Although her pregnancy was not planned, Sherry and her husband were initially excited to have a little brother or sister for their boy. Then Sherry’s early ultrasound showed she had twins. She and her husband spent several weeks eagerly anticipating the growth of their family.
But the next ultrasound showed that the twins are conjoined, or Siamese. The babies are joined at the head, sharing a brain, and chest, sharing a heart. They have two spines, four arms, and four legs. It would be impossible to separate them. If they survive after birth, it would only be for a few minutes. One heart can’t keep two bodies alive. The risk of stillbirth is also very high.
Now 19 weeks into her pregnancy, Sherry tells me she is depressed. She wakes up every morning wondering if today will be the day her babies will die inside her. How would she deliver them? She knows that she would probably need a cesarean section because their combined size might make them too large for the birth canal. Sherry then imagines carrying the twins for another four and a half months. She sees herself delivering stillborns or watching her babies die minutes after their birth.
Sherry must decide whether to continue her pregnancy. An abortion might give her and her husband some emotional relief. And if the twins are small enough, she might not need surgery to remove them.
But because Sherry’s insurance will not pay for her abortion, she has to worry about money on top of her other fears. She is on Medicaid, which will cover the twins’ delivery, alive or dead, but not an abortion—fetal abnormality isn’t enough to get around the Hyde amendment. Although the abortion would be less expensive in a clinic, Sherry would have to go to a hospital since she could need surgery. She would be responsible for the entire bill of at least $10,000 to cover the operating room, anesthesia, medication, and other fees. This expense would destroy her family’s financial well-being.
Sherry can carry her babies to term who cannot and will not live, or she can have an abortion and possibly bankrupt her family.
Sherry’s pregnancy is medically rare, but her dilemma about money is all too familiar. When a woman doesn’t have insurance coverage for abortion, she and her family suffer.
]]>This isn't to say that "Precious" should be read only as a piece of political commentary--it's a work of art first and foremost. But it's hard not to see the parallels. Congress continues down the path of separating women into two groups--women of means who have reproductive rights and women without economic, social or geographic privileges who lack them. Meanwhile women are flocking to theaters to see Precious Jones dream of being someone who, in her mind, matters: a white married woman who lives in Westchester. Her innermost thoughts echo the divide that Stupak-Pitts would put on the books.
Social critics and film critics alike are divided on whether "Precious," the story of an obese, illiterate, victimized young African-American woman's self-actualization through literacy, constitutes "poverty porn," an unrealistic "fairy tale" or something with a "spirit that soars." This polarizing effect arises from the film's methodology: like many politically-conscious artists before them, filmmaker Lee Daniels and author Sapphire have stacked circumstances against a protagonist until it's almost unbearable, then given her a shot of hope. Precious is raped by her father, beat up by her mother, scorned by everyone else. While the story itself hearkens back to The Bluest Eye and The Color Purple, Clarisse "Precious" Jones also recalls a character in a Victorian "social problem" novel. A child herself and pregnant with her second baby by her father, she is both an Oliver Twist and a Tess Durbeyfield, shunned and dismissed as less than human by everyone around her (and perhaps the audience initially), but with an inner light that throws her corrupt, decaying society into relief.
Subtle it isn't, but the story has a mass appeal and an absolute urgency in making viewers interrogate their own assumptions. The question of bodies hangs over the whole film. Everyone around Precious violates her bodily autonomy, from her father to her mother who physically, verbally and sexually torments her, to the school officials repulsed by her pregnancy to boys on the street who ignore, mock or push her. Her very presence is treated as an affront: too large, too dark, too sexual, too hungry.
Precious herself believes this. She longs to be thin and "light-skinned" or white--she suffers deeply from internalized racism and sexism. During her most harrowing moments she has fantasies about being on the red carpet or in music videos, showing the power of pop cultural images to create teenagers' aesthetic values and perhaps cause self-worth to plummet. Precious's dad is almost entirely off-screen, but his shadow looms: Precious's mother Mary, is in thrall to his presence, deeply jealous of her daughter because she has unwillingly captured this monstrous man's attention (and because her daughter's swelling belly symbolizes her own inability to parent). This is her excuse for throwing fists, kicks, taunts and household objects at Precious.
The film's two female-only spaces, the stifling, horror-filled home with Mary, and the limitless school room, are study in contrasts. Precious's mentor, an alternative-education teacher named Blu Rain, is in a loving lesbian relationship. Precious finds her voice among this group of young women like herself, all learning to read together. In Precious's life, the sole male hero is a gentle nurse who doesn't mind being teased about his job. In this way "Precious" doesn't indict men as much as reject the patriarchal values of dominance and competition, in favor of cooperation, communication and nurturing.
"Precious" puts its greatest faith in the transformational ability to express ourselves. Precious, formerly illiterate, recites the ABCs in her darkest moments; her burgeoning ability to put pen to paper is her salvation. In the "real world" this message rings true: literacy in the broader sense is absolutely essential to the formation of a self, the ability to establish boundaries and envision a future. Precious doesn't fully grasp what has been taken away from her until she begins to understand and accept who she is: not only through building her vocabulary but through learning to "read" personal, social, and emotional situations.
The film asks that we never see Precious herself as a symbol. She's a real person with a sharp sense of humor and desires that are hers alone. Still, that personalized story makes a statement. Beneath the scenes of depravity and misery which make the audience gasp or shield its eyes, "Precious" is an affirmation, a reminder that the people we may ignore on the street (or when we pass bills in congress) have unique souls. It's also reminder that government programs, when actually staffed by decent people, can truly help: an alternative school, a halfway house, a counselor end up helping Precious save herself.
"Precious" is a complex, sometimes difficult work of art whose underlying politics matter mostly in service to its heroine's story. I recommend the pieces below for some nuanced analysis of the film's content. For some viewers, the film's broader critiques are overshadowed by the horrifying (and perhaps stereotypical) spectacle of Mary's persona. For others, the casting of lighter-skinned actors in the heroic roles reinforces the colorism the story aims to combat.
But flaws aside, the film's messages are worth pondering at this difficult moment for American women. Restrictions like the Hyde Amendment and Stupak-Pitts don't just divide women into have and have-nots, but also into "good" and "bad." The fact that until this week, the RNC provided abortion coverage to its own members proves again that bills like this are less about saving fetuses and more about punishing certain women and refusing the social safety net to those deemed "undeserving." But "Precious" asks us, all of us, to see deserving and undeserving in a new light.
The film's release in tandem with the Stupak-Pitts disaster strikes back
against the amendment's underlying assumption: the belief that some people are
worth more than others, that some bodies deserve less protection than others,
and that some stories don't need to be told.
Other great commentary on "Precious":
Nina Sankovitch: Why
Precious Matters HuffPo
Why Hasn't Precious Received "The Color
Purple" Treatment? The Root
Slowly but Surely,
"Precious" Finds Success, Criticism, Jezebel
Of "Precious,"
Percival and My Pafology,at Racialicious
Long Day's Journey Into
Night: Watching Precious, Reading Push Racialicious
No longer are we forced to wear skirts, or cover our faces. This is blurring our gender binary system, by letting female identified women come together and wear what they want, when they want it. Transgendered people are a natural ally in this movement, because we too are blurring the gender binary. Some of us that are transgendered are very clearly male identified or female identified regardless of what we were assigned at birth. But others are less clear from a social standpoint and have a very strong sense of self that exists somewhere in between. This blurring of the gender binary is a wonderful thing, because it lets all of us be who we are and be treated with respect for our identities.
Yet, transgendered people regularly suffer violence, and even death for simply being who we are. We are still classified as having a mental health disorder, even though leading transgendered scholars have proven that it doesn't help us at all. Many of us have a very hard time after transition staying in our chosen profession, and we end up doing all sorts of socially unacceptable jobs, including sex work, which further puts us at a social disadvantage. When police are regularly documented beating us up, when nobody ever looks for our killer, when society doesn't let us go to the bathroom in peace, we know it's time for change.
Yet there is change, we've actually caught, gone to trial and successfully convicted someone for the murder of a transgendered person, which is rare. Federal laws are being talked about, however misguided they may actually be, and yet the number of deaths is rising, not falling. Some counts have the average number of murders of transgendered people at 19 per month! Or put another way, 1 in 12 of us in America will be murdered. But we as transgendered people are the only ones counting, in pretty much every country across the world. I'm a transgendered sex worker, and I want to not get killed for who I am or what I do. As our death count rises, I beg that you consider your prejudices around gender, and let us live in peace. I'm literally begging for my life.
]]>
The GOP smoke, mirrors and misinformation campaign has geared up its attacks on the Senate bill focusing on.....you guessed it....misinformation about coverage of abortion care.
A post being circulated from the GOP Leader Blog states "Senate Majority Leader Harry Reid’s (D-NV) massive, 2,074-page bill would levy a new “abortion premium” fee on Americans in the government-run plan."
Let's do a Fiction v. Fact Analysis here:
FICTION: The GOP blog states:
Beginning on line 7, p. 118, section 1303 under “Voluntary Choice of Coverage of Abortion Services” the Health and Human Services Secretary is given the authority to determine when abortion is allowed under the government-run health plan. Leader Reid’s plan also requires that at least one insurance plan offered in the Exchange covers abortions (line 13, p. 120).
FACT: What the bill does say:
Abortion cannot be a mandated benefit as part of a minimum benefits package. A qualified health plan would determine whether it will cover: a) no abortions or only those abortions allowed under Hyde (rape, incest and life endangerment) or b) abortions beyond those allowed by Hyde.
According to Senate aides:
The Patient Protection and Affordable Choices Act (PPAC) does not require health plans to cover abortion. No health plan will be required to cover abortions in their benefits package.
Just like in today’s private insurance market, the Patient Protection and Affordable Care Act will not force or prohibit health plans from covering abortion. And no one will be forced to enroll in a plan that covers abortion services - individuals will be able to choose from a variety of plans in the Exchange which will include both pro-choice and pro-life plans.
This is in fact a change from past practice: In the current marketplace, there is no guarantee that a pro-life person can buy a policy that doesn't offer abortion coverage.
FICTION: The GOP post states:
What is even more alarming is that a monthly abortion premium will be charged of all enrollees in the government-run health plan. It’s right there beginning on line 11, page 122, section 1303, under “Actuarial Value of Optional Service Coverage.” The premium will be paid into a U.S. Treasury account – and these federal funds will be used to pay for the abortion services. [emphasis added].
Section 1303(a)(2)(C) describes the process in which the Health Benefits Commissioner is to assess the monthly premiums that will be used to pay for elective abortions under the government-run health plan and for those who are given an affordability credit to purchase insurance coverage that includes abortion through the Exchange. The Commissioner must charge at a minimum $1 per enrollee per month.
FACT:
In other words, the bill goes out of its way to segregate private premiums that *might* be used to cover abortion care from public dollars.
If the Secretary chooses to cover abortion services in the public plan beyond those allowed by Hyde, he/she must:
And...you know there always is a little bit of hypocrisy mixed in with anything that comes from anti-choice misinformers.
Here's today's serving.
The GOP post claims that the Senate bill is a "monstrosity [and] an affront to the American people and drastically moves away from current policy."
Umm.......no.
It not only preserves current law, but goes beyond current law. See our post here.
Again, from this morning's post: "Abortions currently permitted by Hyde shall be covered in the Community Health Insurance Option to the same extent as they are under Medicaid (only cases of rape, incest and life endangerment)."
No change there, unless you also find the bogeyman under your bed, and think Harry Reid is implanting listening devices in your molars.
The GOP blog then goes on to declare:
The National Right to Life Committee has called the Reid abortion language “completely unacceptable.” The American people deserve more from their government than being forced to pay for abortion.
Well....just let's remember that last week the Republican National Committee was caught with its proverbial pants down when it was discovered that its own health policy--under CIGNA--has covered abortion care for the past 18 years, AND that they had declined to sign a rider eliminating that coverage from their policy....for 18 years.
A Cigna spokesperson told Politico that: Our "products ‘are designed to meet the requirements of our individual employer clients. Employer clients are informed of the services covered and it is their choice to decide which benefits meet their needs.’”
And as was pointed out in Time, “As it happens, Focus on the Family provides its employees health insurance through Principal, an insurance company that covers ‘abortion services.’ A Focus spokeswoman confirmed the fact that the organization pays premiums to Principal, but declined to comment on whether that amounts to an indirect funding of abortion."
Amy Sullivan wrote:
If health reform proposals have a fungibility problem, then Focus does as well. And if they don't think they do have a fungibility problem, then it would be interesting to hear why they think the set-up proposed in health reform legislation is so untenable.”
Facts. They're inconvenient when you just want to spew ideology.
Jus' sayin....
]]>
“I am pleased that the U.S. Senate has maintained current law when addressing the abortion issue. By adopting a common-sense abortion provision, the U.S. Senate ensures that no federal funds will be spent on abortion coverage while not further restricting a woman’s right to choose. The health care bill is about providing access to quality health care to over 36 million Americans. I encourage the U.S. Senate to work towards producing a bill that works for everyone.”
Rep. DeGette collected over forty of her House colleagues signatures on a petition that warned they would not vote for health care reform legislation that includes the Stupak Amendment. DeGette also says, in an interview with Brian Beutler at TPM, that many of the anti-choice House Democrats who voted for Stupak didn't understand the full impact Stupak would have on abortion coverage:
DeGette says she's spoken in private to many of the pro-life Democrats who voted for the Stupak amendment, some of whom have acknowledged that they didn't realize what they were voting for.
"I will say that I have spoken privately with several pro-life members about the Stupak amendment, and they acknowledged that the Stupak amendment goes far beyond where they thought it did," she told me.
Now that the Senate bill has been released, preserving private abortion coverage while maintaining the status quo in regards to federal funds for abortion, what are the prospects for what abortion coverage will look like in a final health care reform bill?
On Tuesday, DeGette told The Atlantic, "We're still willing to talk about language...If there's language that can augment or supplant or replace the Capps amendment, that can have the effect of preserving the status quo, then we would accept that."
]]>
As Jodi writes today, Senator Reid released the Patient Protection and Affordable Care Act last night - and women's health advocates can breathe a sigh of relief. The bill, which would cost $848 billion over ten years, contains provisions to ensure that private insurance coverage for abortion services are retained. According to The Progress Report put out by Think Progress,
Under the merged Senate bill, federal dollars could be used only to pay for abortions when the pregnancy threatens the life of the mother or results from rape or incest; private premiums would be used to pay for any other type of abortion, including those for health reasons. Each plan in the Exchange would decide whether to cover additional abortion services and at least one plan in each market must offer abortion services and one plan must not. In the public option, the Secretary of Health and Human Services can cover abortion only if the procedure is financed with private funds.
This is a complete departure from the House bill's Stupak Amendment which bars even private insurance coverage from covering abortion for women, going far beyond simply maintaining the Hyde Amendment (which bars federal dollars from paying for abortion services except in particularly extrreme circumstances).
John Richards, writing on the The Nation's web site, calls The Stupak Amendment "draconian" and notes that the Senate rejected "anti-choice extremes" in their bill. But he says more hard work is still ahead:
Pelosi will have her work cut out for her. And she will, unquestionably, need an assist from the White House.
In other words, while the Senate may clean up some of the mess, it will take a major intervention by President Obama to wrangle the votes needed to pass a healthcare reform bill that maintains existing rules with regard to abortion.
For a quick break-down of exactly what how the Senate bill treats insurance coverage of abortion, read Jodi's post.
Placing Your Faith In Health Care Reform?
Jon O'Brien, President of Catholics for Choice responds eloquently, as a man of faith, to Jim Wallis' (Christian leader and writer/author who has been involved in the common ground efforts put forth by President Obama) claims that the culture wars have "started up again" as a result of the health care reform bill. In Wallis' post, he lends credence to anti-choice Democrats charge to restrict abortion access by chalking it up to their feelings of exclusion around the abortion conversation (I am not making this up):
I believe there were some sincere early efforts by leaders on both sides to abide by what became known as "abortion neutrality." But somewhere along the line, the process broke down. Instead of building on the initial common ground of neutrality and bringing both sides together to hammer out compromises, many pro-life Democrats felt excluded from the conversation about how abortion would be addressed in the bill.
But Jon O'Brien doesn't buy it:
Jim is mistaken. The antiabortion side decided that it was not interested in any compromise, hence the "my way or the highway" showdown between on one side Bart Stupak and the US Conference of Catholic Bishops and Nancy Pelosi and the Democratic leadership on the other. Therefore they pushed us beyond a compromise, "the current law, abortion neutrality and the status quo." In fact, this is particularly hard to fathom--given the demand by Bart Stupak and others that the bill would fail if their language, and no version thereof was acceptable, was not given a vote and included in the final bill to pass the House of Representatives.
O'Brien's point-by-point analysis of and response to Wallis underscores exactly why the Stupak Amendment was/is as far from "compromise" as one can get when it comes to abortion access under health care reform.
Tapped also has a great piece by Sarah Posner on faith and The Stupak Amendment. Posner argues that the fight for The Stupak Amendment was no common ground effort at all but solely about blocking legal access to abortion:
The anti-choice Democrats who allowed Bart Stupak to be their ringleader now risk being seen as more aligned with the religious right than with their own party. As I reported at RD [Ed note: Religion Dispatches], while the Catholic bishops were in Nancy Pelosi's office late that Friday night, the religious right -- and Democrats for Life of America -- were rallying the religious right's base to push members of Congress to settle for nothing less than the Stupak amendment. Their goal, as we know, is blocking access to legal abortion, and a new study from the George Washington University School of Public Health and Health Services maintains the Stupak amendment would, over time, end all insurance coverage for abortion services.
Washington DC Insurance Commissioner Says No Birth Control Coverage for You!
Washington DC mayor Adrian Fenty appointed Gennet Purcell as the district's new insurance commissioner this summer. While the appointment was covered in the media, one recent change under Purcell's watch has somehow flown under the radar.
Under Purcell's watch, private insurance companies operating in Washington DC are now allowed to opt out of covering contraception in individual plans. This coverage is considered "non-mandatory" by the insurance commissioner and some women are finding their birth control coverage suddenly dropped.
A petition has been started, on twitter, to raise awareness and grab the commissioner's attention that allowing insurance coverage of birth control to become non-mandatory for those not in a group plan is unacceptable. You can sign here.
More Reproductive and Sexual Health News From Around the Web:
11/18
Poll: Most favor tight abortion language United Press International
RealClearPolitics - Fallacies on Abortion Coverage RealClearPolitics
From Hyde to Stupak, over 30 years of limiting access to abortion ... Feministing
Bishops discuss authority over Catholic colleges San Jose Mercury News
Stung by restrictions in healthcare bill, abortion rights supporters fight back Los Angeles Times
Legislature advances abortion amendment Salt Lake Tribune
Matthew Yglesias » Study: Stupak Would Lead to Abortion Coverage Phaseout ThinkProgress
Reid modifies abortion provisions but eschews Stupak language The Hill
Read The Abortion Compromise In Harry Reid's Senate Health Care Bill Huffington Post
Mexico anti-abortion fight moves to federal level The Associated Press
Senate Wording Angers Abortion Opponents New York Times
Reid's restrictions on abortion Politico
Birth control: the most effective way of reducing greenhouse gas emissions Times Online
Manila warned on population Business Mirror
Will You Have To Ask Your Employer For The "Abortion Rider”? ... Change.org
US funding revamps African contraceptive drive AFP
Clerics role sought for family planning The Nation, Pakistan
Obama Opposes Pro-Life Efforts in Health Care Reform The New American
Report: SarahPAC scrubbed site to ward off pro-life critics Raw Story
Pro-Abortion Leader Claims Pro-Life Democrats Will Oppose Stupak Next Time LifeNews.com
Accepting the Stupak Amendment The Atlantic
Mr. Stupak: I Can Stand the Heat Huffington Post
Why I love Sarah Palin National Post
Kennedy, Catholic Church, and Politics of Compromise The Phoenix
Stupak Abortion Measure Stopped...for the Moment Newsweek
Pro-Choice Dems Seize On GWU Study On The Stupak Amendment Firedoglake
11/19
Birth control vaginal ring launched in India Times of India
Bishop reiterates pro-life commitment in defense of CCHD Catholic News Agency
Celebrate loving families on National Adoption Day The Desert Sun
]]>
Here we outline how this bill treats the issue of abortion care, a focal point the past few weeks of lobbying by anti-choice forces and of much debate.While these provisions are now in the bill, it is likely that some Senators will seek to amend the bill to weaken these provisions. Once the Senate bill passes, a conference committee will take both bills to rectify differences between the two. For numerous reasons, the fact that the language below appears in the bill introduced yesterday by Senator Reid does not guarantee that such language will be the final outcome, so the process of getting to conference is a critical aspect of the next steps in this debate.
What does the Senate bill say?
The legislation does NOT include the more extreme and restrictive Stupak-Pitts language adopted by the House:
The Senate’s compromise approach closely mirrors the Capps language which was originally included in the House and Senate Finance Committee bills, with an additional provision stating that the HHS Secretary must ensure that no federal funds are used for abortion, if he/she determines that abortion should be a benefit in that plan.
Key Provisions:
1. Voluntary Choice of Coverage of Abortion Services:
Abortion cannot be a mandated benefit as part of a minimum benefits package. A qualified health plan would determine whether it will cover: a) no abortions only those abortions allowed under Hyde (rape, incest and life endangerment) or b) abortions beyond those allowed by Hyde.
2. No Federal Funds for Abortion Coverage in the Community Health Insurance Option:
If the Secretary chooses to cover abortion services in the public plan beyond those allowed by Hyde, he/she must:
3. State Flexibility and the Community Health Insurance Option States may require the coverage of additional benefits in the Community Health Insurance Option, but must assume costs associated with covering these benefits.
A State may elect to require coverage of abortions beyond those allowed by Hyde only if no Federal funds are used for this coverage. The U.S. Government may not bear the insurance risk for a State’s required coverage of abortions beyond those allowed by Hyde.
4. Hyde Amendment Exceptions and the Community Health Insurance Option:
Abortions currently permitted by Hyde shall be covered in the Community Health Insurance Option to the same extent as they are under Medicaid (only cases of rape, incest and life endangerment).
5. Consumer Choice Assured Among a Variety of Plans in the Exchanges
The Secretary would ensure that in each State Exchange, at least one plan provides coverage of abortions beyond those permitted by Hyde and at least one plan does not provide coverage of abortions beyond those permitted by Hyde.
6. Strict Prohibition on the Use of Federal Funds to Pay for Abortion Services
No tax credit or cost-sharing credits may be used to pay for abortions beyond those permitted by the Hyde Amendment (only cases of rape, incest and life endangerment).
7. Segregation of Funds
Issuers of health insurance plans that offer coverage for abortion beyond those permitted by the Hyde amendment must segregate from any premium and cost-sharing credits an amount of each enrollee’s private premium dollars that is determined by the Secretary to be sufficient to cover the provision of those services.
8. Actuarial Value of Optional Service Coverage
The HHS Secretary would be required to estimate, on an average actuarial basis, the basic per enrollee, per month cost of including coverage of abortions beyond those permitted by the Hyde Amendment. In making such estimates, the Secretary may take into account the impact of including such coverage on overall costs, but may not consider any cost reduction estimated to result from providing such abortions, such as prenatal care. In making the estimate, the Secretary would also be required to estimate the costs as if coverage were included for the entire covered population, but the costs could not be estimated at less than $1 per enrollee, per month.
9. Provider Conscience Protections
No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.
10. Application of State and Federal Laws
No pre-emption or interference with State laws. State laws regarding the prohibition of or requirement of coverage or funding for abortions and State laws involving abortion-related procedural requirements are not preempted. The provision similarly provides that Federal conscience protections and abortion-related antidiscrimination laws would not be affected by the bill. The rights and obligations of employees and employers under Title VII of the Civil Rights Act of 1964 would also not be affected by the bill. In addition, this bill does not affect State or Federal laws, including section 1867 of the Social Security Act (EMTALA), requiring health care providers to provide emergency services.
This article was originally published on HuffingtonPost.com.
Jim Wallis' protracted lecture on how abortion has become a central part of the health care reform debate proves how truth is, indeed, one of the first casualties of war--even a culture war. Here, I examine just a few of his statements to show how his version of events is so far removed from reality that we should reject his premises, arguments and conclusions in toto.
"The culture wars have begun again.
Jim is mistaken. Did the culture wars ever go away?
And if they did, who has reignited the flames? Throughout this process,
we in the pro-choice community have supported health care reform and
worked hard with Members of Congress to pass a comprehensive health
care reform package. We have stayed true to our core values, seeking to
overcome the struggles ordinary Americans have making ends meet. These
struggles mean that many cannot afford basic health care or have to
choose between maintaining their health and paying for other basic
necessities. The anti-choice lobby, with the US Conference of Catholic
Bishops and its Office of Prolife Activities at the helm, has shown
that it is willing to stop at nothing to ensure that its own views,
which are shared by very few Americans, held sway. This lobby, aided by
the 64 Democrats who voted to insert unfounded red herrings into a
critical life-and-death debate over the basic right of access to health
care, exploited the vulnerabilities of the Democratic Party. Wallis is
an exemplar of this lobby, seeking to limit access to abortion at every
turn. He was ably abetted by the self-described "progressive
pro-lifers" like Catholics United and Catholics in Alliance for the
Common Good, whose comparisons of abortion to torture gained resonance
among those who are unyieldingly opposed to women's reproductive
freedoms. We should not forget that Catholics United and Catholics in
Alliance for the Common Good were founded with the support of senior
Democratic strategists--whose main interest was in a Congressional
majority, and not the goals and principles supported by those who might
vote for such a majority.
"Those of us who have worked hard to find some common ground in
this debate, it's now becoming an all win-or-lose situation.... [We
have sought] to help forge some compromise."
Jim is mistaken. He is not interested in any compromise that includes access to abortion. The pro-choice community has been working hard to find a middle ground in the abortion debate. There were those of us who were more than willing to refine the Capps Amendment that was rejected by the anti-choice lobby, but Wallis and his friends worked tirelessly to reject any compromise along those lines. Jim Wallis' limited discussions with the pro-choice community have been obstructionist and unhelpful. As regards compromise, there was, in reality, no room for compromise once the anti-choice movement decided that it was willing to trade health care reform in their desire to further restrict access to abortion.
"The bill that was passed by the House was a huge step toward one of the greatest legislative accomplishments and victories for social justice in a generation."
Jim is mistaken. The bill, as currently constructed, is like passing the Americans with Disabilities Act, but excluding the visually impaired from the protections in the legislation. Leaving out what Jim coyly refers to, with quotes, as "women's health" is anathema to those of us who fight for improved access to women's health care services every day. If we exclude access to abortion for women in this bill, all of the other advances are compromised. Reproductive justice is the basis of women's equality--without it, women become second-class citizens.
"The bill that came out of the House achieves many of the goals of the faith community by providing health care for 36 million more people, or almost 96% of Americans."
Jim is mistaken. The reality is that health care reform was not initiated to achieve the goals of the faith community. The aim of the bill was to provide health care for those who did not have it. Americans were promised that if people liked their existing coverage, they would not lose it. That promise has been broken.
"While we still need to include everybody -- especially immigrants for whom this bill is still very inadequate -- the House vote was a major legislative achievement."
Jim is mistaken. Just as he is willing to throw women's health care under the bus, so is Wallis also willing to throw immigrants' health under the bus. The needs or rights of any group that get in the way of Jim Wallis' definition of what constitutes a "major legislative achievement" are expendable.
"Although the Capps Amendment was meant as a good faith effort to find common ground...it failed to address many pro-life concerns...Capps might have been a fruitful starting point for dialogue."
Jim is mistaken. Polling has shown that many Americans are willing to support a compromise on this issue, such as that outlined in the Capps Amendment. Polls by Catholics for Choice and the Mellman Group prove this. However, this compromise was not enough for anti-choice extremists such as Jim Wallis. We should also remember that it is not always possible to meet people half way. And in such cases, the majority should hold sway. Sadly, the Democratic leadership decided that the minority view, and Bart Stupak's opposition to abortion is the view of a very small minority, would win the day. And American women were the losers.
"Sojourners...worked very hard to find a solution here and were one of the very few groups really talking to both sides."
Jim is mistaken. Sojourners' discussions with the pro-choice side must have been in whispers, because few recall hearing from them and as I noted above, what we did hear was described as obstructionist and unhelpful.
"Because the pro-life side wasn't really invited into a real discussion about possible solutions, the "compromise" missed some important things, misread the real situation, and failed to pass the tests of maintaining current law, abortion neutrality, and the status quo."
Jim is mistaken. The antiabortion side decided that it was not interested in any compromise, hence the "my way or the highway" showdown between on one side Bart Stupak and the US Conference of Catholic Bishops and Nancy Pelosi and the Democratic leadership on the other. Therefore they pushed us beyond a compromise, "the current law, abortion neutrality and the status quo." In fact, this is particularly hard to fathom--given the demand by Bart Stupak and others that the bill would fail if their language, and no version thereof was acceptable, was not given a vote and included in the final bill to pass the House of Representatives.
"Both sides had seemed to agree with the principle that no one should be required to fund abortion if their conscience compels them not to, and that no abortion should be paid for with federal funds."
Jim is mistaken. Both sides had agreed that we would support a bill that would not further either side's agenda. Through our taxes, we are all forced to fund things with which we disagree. For those who support immigration reform, including Jim Wallis we understand, funding for unjust immigration policies should be opposed. Yet we have never heard him support moves that would destroy legislation over those issues. Why is abortion different?
"The pro-choice side acknowledges the conscience argument, but wants to ensure access to legal abortion and believes that such access should not be restricted by those who oppose the law on the grounds of conscience. This tacit agreement also follows public opinion in that a majority of the country doesn't want to make all abortions illegal, but doesn't want public funds to pay for it."
Jim is mistaken. His approach to conscience protections is very one-sided. In fact, we find that a majority of Catholics supports federal funding for abortion, as do other cohorts of the population. The claim that the public is unhappy with federal funding is a myth propagated by those opposed to abortion. Would he have us disregard the consciences of women and men who support abortion access?
"How to protect the consciences of both sides here -- pro-life tax payers and the women who want access to legal abortion -- is a most difficult issue to resolve."
Jim is mistaken. This is a false dichotomy. Prolife taxpayers and pro-choice taxpayers might be a reasonable comparison, or perhaps those who want to preserve access to legal abortion and those who wish to deny access to legal abortion. The circle of people who support choice extends beyond women who want access to legal abortion--it includes men, women who are not able to or no longer able to have children and a host of others. It is, in reality, a simple issue to resolve. All insurance policies, federal and private, should offer medical coverage for legal health services to those who want them. If anybody is uncomfortable about what is offered, they can choose not to avail of those services.
"More than 85% of those women, if present numbers hold up, will pay for the abortion with private funds, and only 13% will use health-care plans to pay for it."
Jim is mistaken. This is one of the many misrepresentations by those who seek to minimize the impact of the Stupak-Pitts amendment. The claim that only a few women will be affected is irrelevant and wrong. According to the Guttmacher Institute, the claim is wrong on three counts:
Their study was of all women who had an abortion in 2001, including women on Medicaid and those who are uninsured--who would not have been able to access coverage for abortion. If we looked only at privately insured women, the percentage of procedures billed directly to insurance companies would be substantially higher than 13 percent.
The 13 percent statistic does not include women who pay for an abortion up front and then seek reimbursement from their insurance provider. This is common when a medical provider does not participate in a patient's insurance plan, as is often the case with small, specialized providers, including abortion providers.
Some of the women identified as paying out of pocket would likely have had insurance coverage for abortion care, but did not know they had it or chose not to use it for reasons of confidentiality. Given the stigma that still surrounds abortion, many women do not want their insurer or employer--or their spouse or parent who may be the primary policyholder--to learn that they had one.
"We could also take the two bills in Congress that seek to reduce abortion by supporting low-income women in all kinds of practical ways -- one with support for contraception and one without."
Jim reveals his real agenda. Despite his carefully nuanced positions, we know that Jim Wallis is anti-choice and opposes access to comprehensive reproductive health services for women. In this passage, Jim Wallis lets his guard down. In Jim Wallis' world, women's health care services are expendable. We can see this in his willingness to allow the debate over abortion to go even further and exclude access to contraception as well. Is the Stupak amendment not enough for him? No, it is not.
In short, Jim Wallis' arguments repeat the talking points of those who have sought to restrict access to abortion since it became legal in 1973. Wallis lays claim to the mantle of negotiator and centrist, the voice of reason in an acrimonious and angry debate. In fact he is the opposite. Wallis is antiabortion, and according to his essay, is open to seeing health care reform go beyond the abortion issue and also restrict access to contraception. His is not the voice of reason, but that of a culture warrior in extremis. The fact that he wears clerical garb should not distract us from the fact that he is more political than pastoral and that one of his goals is to make abortion illegal. Our mantra is "Safe, Legal and Accessible." His is "Dangerous, Illegal and Inaccessible."
I agree with Jim Wallis that the truth has become a casualty in this war. But if Jim Wallis and his conservative allies have their way, women will become another casualty. ]]>The Kaiser Study
"Women have much at stake in the ongoing national debate on health reform," states a new brief by KFF, which continues:
Comprehensive coverage and the scope of benefits are at the heart of making health care accessible to women. The decisions that policy makers enact regarding access and coverage of abortion are sure to be the subject of tremendous discussion and debate, and could affect care for millions of women today and in the future.
The KFF brief compares the bill passed 10 days ago by the House of Representatives with those still working their way through the Senate. (It was written prior to release today of the omnibus Senate bill by Majority Leader Harry Reid.)
"The way that the final House bill addresses abortion coverage has
the potential to affect many women," notes KFF, underscoring the incorrect ways in which the media has portrayed this issue.
"[A]bortion is one of the most common surgical procedures performed on women. In 2005, there were more than 1.2 million abortions in the United States. It is estimated that at current rates, about a third of women will have had an abortion by age 45."
The Kaiser brief first reviews current law, noting:
The House bill expands coverage to many of the nation’s uninsured by extending Medicaid eligibility to all qualifying individuals with incomes up to 150% of the federal poverty level and establishing a national health insurance exchange--a sort of marketplace where individuals with incomes above 150% of poverty can purchase insurance coverage. Initially, the Exchange would be open to all qualifying people who are uninsured and employees of some small businesses, with the possibility of opening it to more people over time. It would offer multiple insurance plans from which individuals can choose including at least one publicly financed plan as well as several privately operated plans. To help individuals purchase insurance, the federal government will provide subsidies (in the form of premium credits) to eligible individuals and families with incomes between 150% and 400% above the poverty level.
The House bill also extends premium credits to individuals with employer-sponsored insurance if their share of premiums exceeds 12% of their income, which could make an additional 1 million people eligible for purchasing coverage in the Exchange.
"In total," notes Kaiser, "it is estimated that 86% of participants in the Exchange would receive subsidies."
Kaiser notes:
The House bill places a number of restrictions on coverage of abortion, with the most direct impact on the plans that will be offered in the new Health Insurance Exchange. According to the legislation, the public plan within the Exchange would be prohibited from providing coverage for abortions beyond those permitted by current federal law (to save the life of the woman or in cases of rape or incest). The House bill also prohibits federal premium credits that low-income individuals will receive from the federal government from being used to purchase a health plan in the Exchange that includes coverage for all but federally permitted abortions. Although it is not required, private insurers may opt to offer a plan in the Exchange that covers abortions beyond those permitted by federal law. These insurers, however, will be required to also offer an identical plan that does not cover abortions for which federal funding is prohibited.
Private plans participating in the Exchange may choose to offer
supplemental coverage for abortions in the form of riders that are totally
separate from other benefits, but that coverage must be paid for entirely with non-federal funds. Furthermore, the plans must be separately operated to assure that federal funds are not used to administer or operate plans that cover abortions.
According to Kaiser, an estimated 12.4 million women ages 15 to 44 are uninsured, 94% of whom would qualify for federal assistance (61% through Medicaid—7.5 million women; and 33% for federal
premium credits subsidies to purchase coverage—4.1 million women).
Impact of the House Bill:
Kaiser states that provisions in the House bill would "have direct effects on women seeking coverage in the Exchange as well as on plans that
offer coverage in the Exchange."
Kaiser underscores what others have also noted:
It is unclear whether a woman would necessarily seek or know to buy a service-specific rider for abortion when she is choosing her insurance plan, or whether women without subsidies would necessarily know whether they are buying coverage from a plan that covers abortion or not. It is also unknown what the price differential would be between the two plans and how much the rider would cost, if offered. The House bill goes beyond the Senate committee bills by requiring the sale of a distinct insurance product that is designed specifically for those receiving subsidized coverage. For insurers, the House bill sets a number of restrictions, particularly the requirement to isolate federal dollars from private funds because a plan that receives any federal funds cannot provide abortion coverage. Although it is hard to predict the response of insurance plans to this type of law, some legal scholars contend that given the size of the potential pool of women and their families that will be eligible for federal subsidies under the exchange and other complexities, this might limit he development of insurance plans that offer either abortion coverage or a rider, and ultimately carry over to products offered in the employer market.
Many women who now have coverage for abortion care would lose it.
This complex combination of restrictions means that many women who will obtain coverage under health reform either through Medicaid or the Exchange would have to pay for an abortion out-of-pocket, the cost of which varies depending on factors such as location, facility, timing, and type of procedure.
A clinic-based abortion at 10 weeks’ gestation is estimated to cost between $400 and $550, whereas an abortion at 20-21 weeks’ gestation is estimated to cost $1,250-$1,800. The vast majority of abortions are performed early in pregnancy. In 2004, 89% were in the first twelve weeks of pregnancy and only 1% were at 21 weeks or later. In general, abortions performed in hospitals are more expensive than those performed at clinics.
The House bill dramatically expands the Medicaid program, and extends insurance to qualifying uninsured individuals with incomes below 150% of the federal poverty line.
"The Medicaid program already serves millions of low-income women," notes Kaiser, "and is a major financier of reproductive health services. It is estimated that two-thirds of adult women on Medicaid are in their reproductive years." In 33 states and the District of Columbia, state Medicaid programs do not pay for any abortions beyond the Hyde restrictions. In these states, an estimated 4.5 million women ages 15-44 are currently uninsured and also have incomes less than 150% of the
federal poverty level. Many of these women would likely qualify for Medicaid under the new House bill.
They will be forced to pay for their insurance with their rights.
The George Washington University (GWU) Study
This study, conducted by the George Washington University School of Public Health, focused on the implications of the Stupak Amendment for the health benefits industry on the whole; the growth of the public market for supplemental coverage: and the implications for covering abortions that are a consequence of an unexpected condition.
The study concludes that:
Stupak-Pitts, according to the authors:
Can be expected to move the industry away from current norms of coverage for medically indicated abortions. In combination with the Hyde Amendment, Stupak/Pitts will impose a coverage exclusion for medically indicated abortions on such a widespread basis that the health benefit services industry can be expected to recalibrate product design downward across the board in order to accommodate the exclusion in selected markets.
In any supplemental coverage arrangement, it is essential that the supplemental coverage be administered in conjunction with basic coverage. This intertwined administration approach is barred under Stupak/Pitts because of the prohibition against financial comingling. This bar is in addition to the challenges inherent in administering any supplemental policy. These challenges would be magnified in the case of medically indicated abortions because, given the relatively low number of medically indicated abortions, the coverage supplement would apply to only a handful of procedures for a handful of conditions. Furthermore, the House legislation contains no direct economic incentive to create such a market [and would leave in doubt] states’ ability to offer supplemental Medicaid coverage to
women insured through a subsidized exchange plan.
The authors write: "The administration of any coverage exclusion raises a risk that, in applying the exclusion, a plan administrator will deny coverage not only for the excluded treatment but also for related treatments that are intertwined with the exclusion."
The risk of such improper denials in high risk and costly cases is great in the case of the Stupak/Pitts Amendment, which, like the Hyde Amendment, distinguishes between life-threatening physical conditions and conditions in which health is threatened. Unlike Medicaid agencies, however, the private health benefit services industry has no experience with this distinction. The danger is around coverage denials in cases in which an abortion is the result of a serious health condition rather than the direct presenting treatment.
Noting that the entire industry may be pushed toward using life-threatening conditions as "the standard," the authors note that "it is likely that all women will risk coverage denials, regardless of the market in which their coverage is obtained," and will lose coverage for medically indicated abortions that may well threaten both health and ultimately life.
Under these circumstances, what is the norm today in the employer-sponsored market – broad coverage of medically indicated abortions – is likely to narrow considerably as the industry seeks to restructure its product design to meet the most restrictive demands. If this consequence flows, then the industry, confronting the challenges of distinguishing between enrollees for a handful of covered procedures and specific conditions, can be expected simply to eliminate certain procedures and conditions from coverage altogether, leaving women and families exposed.
"Stupak/Pitts and Hyde...presume that abortion is the immediate subject of the claim for coverage," note the authors.
But this is not always the case.
High risk pregnancies themselves could be identified as potentially
abortion-related.
Conditions such as diabetes (observed in 1% of pregnancies) which are poorly controlled can lead to serious health consequences for both the woman and the fetus, including major congenital abnormalities, and a higher risk of spontaneous loss, which might in turn trigger an abortion if the pregnancy cannot be saved. Management of recurrent pregnancy loss or complicated multi-fetal pregnancies (increasingly prevalent with widespread use of assisted reproductive technologies) may also be considered abortion-related conditions. Similarly, uncontrolled hypertension, trauma during pregnancy, seizure disorders and other conditions, all require complex management and may persist beyond the pregnancy, and may result in abortion-related care. These concerns have increasing individual and public health consequence as age at pregnancy, body mass index and associated metabolic and cardiovascular abnormalities, Cesarean section rates, multi-fetal pregnancy rates, and use of assisted reproductive technologies have all increased dramatically in recent years.
Additionally, state the authors, "in response to more limited access to abortion services, there may be an increase in self-induced abortion, potentially through increased self-administration of misoprostol. Coverage for treatment of complications such as hemorrhage and incomplete abortion in such cases could be denied."
In these circumstances, how are plan administrators to distinguish between the abortion procedure and the rest of the treatment? Will the entire cost of a course of treatment (e.g., surgery to repair a damaged pelvis following an automobile accident) be denied if violation for paying for the excluded abortions, may elect to deny the treatment altogether, claiming that it is all related to the excluded treatment.
"As the denial is appealed, the financial consequences for patients potentially will be enormous."
"One of the great challenges in insurance reform is the unintended consequences of regulation," write the authors.
The Stupak/Pitts Amendment is intended to reach only a specific part of the market. But the cumulative effect of the provision, in combination with existing federal laws governing Medicaid and federal employee health benefits (as well as the law of certain states) inevitably can be expected to move the entire health benefits industry away from its current inclusive coverage norms and toward a new norm of exclusion. The provisions of the legislation, as well as the technical challenges that arise in benefits administration, militate against the creation of a supplemental coverage market. Thus, if the result of national health reform is to move millions of women into a market that operates subject to the exclusion, then it is fair to predict that the entire market for coverage ultimately will be affected as a product tipping point is reached and virtually no supplemental market appears.
In addition, state the authors:
Given past experience and the sanctions that arise from a violation, it is reasonable to predict that in interpreting and applying the exclusion, health plan administrators will err on the side of coverage denial. This is because the legal risks associated with coverage determination are all on the side of incorrectly awarding coverage, not erroneously denying it. This balancing of risks can be expected to lead insurers to calibrate coverage determinations in a way that works against women whose medical conditions ultimately lead to an abortion that they never willingly sought.
In short, as many have already argued, women will bear the brunt of a policy created based on ideology and discrimination, not public health, pushed through by those who appear to care little for either women's rights or their lives and health.
]]>This article appeared in the Fall 2009 issue of Ms. Magazine and is reprinted here with permission from Ms.
“Our medical experts have determined that your life was not in danger and you could have carried the pregnancy to term. And, by the way, you owe us $9,000.”
Her voice
breaking, D.J. Feldman, a Washington, D.C. federal employee, recently
spoke to the press about her struggles with her insurance company after
she aborted a much-desired pregnancy because of a fetal diagnosis of
anencephaly (the absence of a major portion of the brain, skull and
scalp). The insurance would only cover abortion in the case of rape,
incest or a threat to her life, so the fact that if Feldman had
continued the pregnancy, it would have been both physically and
emotionally grueling—resulting either in a fetal demise, a stillbirth,
or a live birth of a newborn who would quickly die—had no effect on the
insurance company’s decision.
The primary culprit in this situation is not really Feldman’s insurance carrier, however, but the U.S. Congress. For decades it has imposed such unconscionable restrictions on abortion coverage for federal employees, as well as on women in the military, Native Americans using government provided health facilities and women on Medicaid in a majority of states.
Feldman is speaking out now because of her outrage that the notorious Stupak-Pitts amendment to the House health reform measure would extend such federal bans on abortion coverage to the millions of women who are enrolled in the private insurance market. Under this amendment, any insurance plan that wishes to be part of the new national health-care exchange would be prohibited from offering abortion coverage, although most insurance plans currently offer this coverage.
As Nancy Northrup, president of the Center for Reproductive Rights, which organized the press conference at which Feldman spoke, put it: “The ban on abortion coverage represents an enormous and unprecedented incursion into the terms of the private insurance market….Stupak-Pitts would regulate abortion coverage for people working for private employers or those who are self-employed.”
The press conference also featured a television advertisement that has just been produced by the Center which effectively points to the unfairness—if not the absurdity—of such a ban. The ad will run on MSNBC, other cable stations and media websites.
As traumatic as D.J. Feldman’s story is, she acknowledges that she is more fortunate than many other women in her situation, since she and her husband were able to pay for her abortion themselves. But she doesn’t want other women forced into a similar situation, especially those without extra financial resources. Feldman has not only spoken to the press but also visited various Congressional offices to speak against Stupak-Pitts. “I realized I had a moral obligation to speak out,” she said.
]]>To anyone who hopes to accuse us of stinginess, we announce that we’re giving participating mothers $8 per month and children $6 per month in vouchers to purchase produce. Wait it gets better, breast feeding mothers get $10! Yes, that’s right $10 whole dollars to stretch over 30 delicious, vitamin-packed days.
Now what low-income woman wouldn’t want to stay pregnant regardless of her circumstances or desires with that kind of reward on the table? Could it be she’s the one thinking precisely of life -- contemplating the one her child will lead? Or perhaps she’s concerned for her already impoverished existing children and how she will manage an additional one to clothe, feed, shelter and -- dare she hope -- educate.
Right now Congress and armies of lobbyists determine whether women will be deemed worthy of access to the full range of health care the law and medical science allows. We’re hearing lots about the importance of life and the sacred bond of mother and child. So, what about motherhood.
A cursory glance at maternal health will tell you just how much we value how life is given in this country. We advocate for and in some cases force over one-third of women to undergo major abdominal surgery (though we’ve given it a nicer name), rates unknown abroad. We’ve turned a supposedly blessed event into a medical emergency and made sure women are terrified to do it and not empowered at having done it after the fact.
Child-rearing, with its joyous but exhausting and endless responsibilities, is absolutely the last priority on our national list. This is obvious to anyone who has contrasted the palatial “birthing suites” where a woman labors to the dismal recovery room she inhabits once her duty is discharged. Even for those of us on the lucky end of the spectrum, the hospital architects have signaled who and what matters in this purportedly mother-loving place.
Motherhood in any circumstances is a challenge. In fact, my own mother used to say it’s the only life sentence without chance at parole you can receive without committing a crime. Low-income motherhood is infinitely harder still. Where we should be in awe of and reaching out to help the women who daily sacrifice to undertake this feat -- we stand in judgement of them and seek to make their difficult task impossible. Only to insist it must be done.
With forced eviction from the hospital after two days, no postpartum support, miserly provisions for food, questionable access to health insurance, inaccessible but absolutely critical flu vaccines, unsafe and failing schools, little or no assistance with childcare -- how could anyone without wealth be up to the task of raising one, let alone, many children in America? Yet, this is a job description of low-income motherhood here. Now we’re contemplating drafting any fertile female who dares to have sex into this position -- and we’re confused that they’re not so eager to apply.
Child-rearing isn’t battle (as much as parents of toddlers and teenagers might insist that it is.) But it is a sort of national front-line, critical to our survival. It is our future, quite literally, at stake. As our lawmakers now shamefully consider shifting from a voluntary service for this task of national importance to conscripting women to serve at their will -- can’t we at least demand the provisions they need to do the job?
]]>This post was updated at 10:47 p.m. Wednesday, November 18th to include links to articles at other sites covering the Senate health reform bill. Links can be found below.
Based on information available as of this writing, the health reform bill unveiled by Senate Majority Leader Harry Reid does not contain language similar to the Stupak amendment.
An existing law, known as the Hyde amendment, already prohibits federal money from paying for abortions except in cases or rape or incest or when the woman's life is endangered. Anti-abortion-rights lawmakers, however, argued that the House bill and the measures approved by two Senate committees would have circumvented that law.
The article quotes Senator John Kerry (D-Mass.), who is pro-choice, as saying Reid's new provisions would preserve the Hyde amendment while enabling people to buy insurance plans with abortion coverage on the exchange.
"We're basically going to keep current law, which is what we ought to do," Kerry said after the Democratic caucus meeting.
Another article by Huffington Post reports:
The health care reform package unveiled by Senate Majority Leader Harry Reid (D-Nev.) Wednesday night bars the use of federal funds for abortion services, but does not go as far as the House bill -- which prevents women in many cases from buying insurance with their own money that covers abortion.
The Senate version would require at least one plan within the health insurance exchange that the bill sets up to offer a plan that covers abortion and one that doesn't. It would also authorize the Health and Human Services Secretary to audit plans to make certain that abortion isn't being paid for with federal dollars.
In a statement shared by her office with RH RealityCheck, Congresswoman Lois Capps (D-CA), author of the original Capps amendment in the House bill, said:
“I am pleased that the Senate has adopted a reasonable, common ground approach on this difficult question. It appears that their approach closely mirrors my language which was originally included in the House bill. It ensures that federal funds do not pay for abortions but allows continued access to this legal medical procedure. This is a bill about health insurance reform not about expanding or contracting access to abortion services. I am glad that the Senate has rejected the more extreme Stupak language and look forward to continuing to work with my pro-life and pro-choice colleagues on a reasonable compromise on this issue.”
Michigan Congressman Bart Stupak worked with other anti-choice Democrats and the United States Conference of Catholic Bishops to insert a new amendment into the House health care bill that, if signed into law, would dramatically alter women's access to insurance coverage for abortion care.
Links to other articles:
Details of Senate HCR Bill Emerge, Reconciliation On The Table, Daily Kos - Joan McCarter
Senate Opt-Out Public Option Won’t Start Until 2014, And Won’t Cover Abortion Procedures, Open Left - Chris Bowers
Reid Outlines Bill For Caucus, Warns Conservative Dems That Reconciliation Is Still An Option, TPMDC - Brian Beutler
Health Bill CBO Score: $849 Billion Over Next Decade, HuffPost - Sam Stein
Reid: ‘We’re Real Proud Of These Figures’, TPMDC - Brian Beutler
Senate Health Care Bill Covers 94%, Costs $849B, Reduces Deficit By $127B, All Over 10 Years, OpenLeft - Chris Bowers
CBO Says Senate Health Bill Would Cover 94% of Americans, Sharply Reduce the Deficit, Think Progress - Matt Yglesias
CBO: Senate Bill Cuts $127 Billion From Deficit In First, Decade, Covers 31 Million, WashingtonPost.com - Ezra Klein
Reid’s Bill Includes Public Option With Opt-Out And Tax On “Cadillac Plans”, AMERICAblog - Joe Sudbay
First Look At The Senate Bill (Updated), The New Republic: The Treatment, Jonathan Cohn
CBO: Health Reform Reduces Deficit By $777B/20 Years, MyDD - Jonathan Singer ]]>
The new guidelines state that instead of receiving yearly mammograms beginning at age 40, women can now wait until 50 years old to begin the annual screenings. But the new recommendations set off a firestorm of frustration from particular groups like the American Cancer Society and caused confusion as well. There are claims that these new guidelines will put women in greater danger, particularly African-American women, who have the highest rate of death from breast cancer and are more likely to develop breast cancer before age 40.
The guidelines are clearly controversial with the debate focusing on whether or not breast cancer screenings at an earlier age are statistically helpful, whether the risk of exposure to radiation and the chances of false-positives and misdiagnoses are great enough to warrant this change or why the many women's lives who have been saved by early detection and early screenings are not reason enough to keep the guidelines status quo.
So, what's a woman to do?
Our Bodies, Our Blogs does an excellent job at breaking down the new guidelines: what they mean, why there were re-adjusted and how a woman can evaluate what's best for her given the new landscape.
In her post, New Mammogram Guidelines Are Causing Confusion, But Here's Why They Make Sense, Christine Cupaiulo writes:
But a number of women’s health organizations, including Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action, for years have warned that regular mammograms do not necessarily decrease a women’s risk of death. Premenopausal women in particular are urged to consider the risks and benefits.
Cupaiulo confirms that far from disempowering women to take care of their health, these new guidelines align with the World Health Organization's recommendations, and may help women to have a clearer understanding of the health impact of mammograms:
I don’t believe the new guidelines are politically motivated, nor are they “patronizing” to women simply because they call into question the stress related to biopsies and false positive results. Rather, the guidelines provide a useful framework for helping each of us to decide when is the best time to begin screenings and the intervals at which they should be repeated.
The guidelines are in sync with international recommendations; the World Health Organization recommends starting screening at age 50, and in Europe, mammograms are given to post-menopausal women every other year and detection rates are similar to the United States. During an interview on MSNBC on Tuesday, breast cancer expert Dr. Susan Love said the government’s guidelines bring us into line with the rest of the world and with current research. (Read more at her blog.)
In response to the claims that these new guidelines will ultimately affect insurance coverage for mammograms, Cupaiulo quotes a New York Times recent article which, in part, explains:
The guidelines are not expected to have an immediate effect on insurance coverage but should make health plans less likely to aggressively prompt women in their 40s to have mammograms and older women to have the test annually.
But, here's the thing. Cupaiulo is careful to note that there is no reason why women should not be encouraged to continue to make their own decisions they feel are right and best for their health and lives.
If you’re reading this and thinking you still want to keep that scheduled mammogram, you should certainly do so.
“No one is saying that women should not be screened in their 40s,” said Petitti, the task force vice chair. [Ed. note: of the advisory group that released the new guidelines] “We’re saying there needs to be a discussion between women and their doctors.”
Dr. Amy Abernethy of the Duke Comprehensive Cancer Center said she agrees with updated recommendations.
Tara Parker Pope, writing at The New York Times blog in Our bodies, Our Breast Exam also quotes Dr. Petiti,
Dr. Petitti also wanted to clarify that the new recommendations did not tell women to stop doing breast self-exams, just like they did not tell women not to have mammograms until age 50. Rather, the advisory group recommends against routine mammography in younger women.
“Nothing in our recommendations says that a woman who finds a lump shouldn’t go to her physician,” Dr. Petitti said.
For some women for whom the anxiety of false-positives, exposure to radiation over a span of years or opening themselves up to surgery to remove a lump that may never have been harmful in the first place, these recommendations may elicit a sigh of relief. But for many others, the personal experience of losing someone close to breast cancer or receiving a diagnosis of breast cancer via a mammogram at an early age, these new guidelines don't feel right.
Read more at Our Bodies, Our Blog.]]>
Minnpost, a Minnesota-based online news site, reports that key figures in the religious pro-choice movement are beginning to move their members to ensure their voices are heard as well. Kelli Clement, co-chair of the Minnesota Religious Coalition for Reproductive Choice , leads the call:
No person I've ever known thinks that abortion is something a woman wants to do. It's a terribly difficult choice. It's a sacred choice. But no one chooses for you. No church. No insurance company and certainly the Congress shouldn't get to choose for me."I want lawmakers to uphold their oaths," said Clement. "I want them to uphold the rights of other people. Abortion is a legal form of medical care. It's federally protected. I want it supported."
Backlash in Minnesota isn't coming just from pro-choice religious groups, but from politicians as well. Former Minnesota State Senator Dave Durenberger spoke scathingly on the National Institute of Health Policy site regarding what he sees as an overstep of the Catholic Bishops authority in pushing the amendment into the health care reform debate.
"As a Catholic Republican," stated Durenberger, "I am puzzled by the way in which mere mortals can shift the moral priorities of a Church over what, for a 2,000-year-old religion, is a relatively short period of time. As a new member of the U.S. Senate, I stood proudly with my Church in opposition to the expansion of the nuclear arms race, in definition of a just war, in efforts to reduce racial and economic discrimination and enact historic civil rights legislation.
How did a national law to prevent insurance companies, whose premium costs are defrayed in part by tax subsidies, from providing medical services related to abortion get to be a higher public priority for all Americans, not just Catholics, than financing access to health care services? Especially when it is unlikely this law will have that great an impact on the number of abortions performed in this country."
As more people continue to speak out against the role the Catholic Bishops had in instituting this extremely flawed amendment, will we see it removed from the health care debate? Only time will tell.
]]>